Grand Strand Regional Medical Center's upgrade to a level two trauma center shouldn't have much of an impact on where emergency response workers send trauma victims, but Horry County emergency officials and area hospital leaders met Wednesday morning to discuss the system and air concerns.
On Nov. 1 Grand Strand Regional Medical Center began operating as a level two trauma center, starting a yearlong evaluation period as it seekscertification from both the American College of Surgeons and the S.C. Department of Health and Environmental Control.
Lewis Dickinson, the medical director of trauma for Grand Strand Regional Medical Center on Wednesday detailed some of the additional staff, capabilities and equipment that have been added to comply with the level two trauma requirements. The hospital has added about 45 staff members and now has a trauma surgeon, operating room team and other emergency staff at the hospital 24 hours a day to comply with the more stringent level two requirements.
The general rule for Horry County's emergency medical technicians is that if they don't directly pass another emergency room they should take trauma patients to Grand Strand Regional Medical Center. If another emergency room is closer, then the EMT should call the closest hospital and let a doctor make the call of whether the patient needs to go to Grand Strand Regional Medical Center, said Matthew Smith, the chief of medical operations for Horry County Fire Rescue. While the guidelines will be followed, some decisions on where to send a patient will be made on a case by case basis as the situation demands, he said.
"It's a unique set of circumstances, unique challenges and demands," Smith said. " [That is] one of the reasons that we wanted to have this forum."
The guidelines about where a trauma victim should be taken are determined with guidelines set by the Department of Health and Environmental Control and the American College of Surgeons and as a level three trauma center Grand Strand was already seeing many of those patients, Smith said.
Both Conway Medical Center and Loris Community Hospital used to be level three trauma centers but both let the designation lapse due largely to cost concerns.
Officials from both of those hospitals had some concerns about when patients would bypass their emergency rooms but credited Grand Strand Regional Medical Center with stepping up to provide level two trauma services in the area.
"We're worried about people injured in our immediate area being taken to Grand Strand when we could adequately take care of them," said James Craigie, the vice president of medical affairs for the Loris Healthcare System.
He said his concern was with emergency workers in the field making the decision and the possibility that local patients would be sent away.
Smith said that Horry County Fire Rescue is aware of the relationships that hospitals create with members of their community and doesn't want to get in the way of that relationship.
"When you take a patient from one area to a different facility there are always questions about how you're going to make that decision," he said.
Smith said that when patients, who may have been born at Loris Community Hospital and have always gone there, are taken to Grand Strand in an emergency ask hard questions of the local hospital afterwards, those hospitals often first question whether the patient should have been taken there in the first place.
"What they want to be sure of is that we are not disrupting that relationship," he said. "We want people to know that we respect the people and the facilities that work for health care in this area."
Area hospitals raised questions when Grand Strand stepped up cardiac care and severe heart attack cases started going straight there, Smith said.
Edward King, the medical director of Conway Medical Center, said this situation parallels what happened with heart attack transports, which created some discussion but works well.
"It's pretty much protocol driven guidelines. It's hard to argue with it," he said.
King said once again Grand Strand has made the move to provide a service that is unique to the area, which he said would be a valuable asset to the community.
Conway Medical Center can and does treat trauma patients and that despite no longer being certified as a level three trauma center the hospital still has all the same capabilities, he said..
Smith said that Horry County Fire Rescue has no intention of diverting noncomplex trauma patients from the noncertified hospitals.
Ensuring an openness and understanding of how those decisions are made was one of the main purposes of the forum and Smith proposed a committee of various hospitals and Horry County Fire Rescue that will review and evaluate where trauma patients are sent.
If the result is that the wrong decision was made then it is a learning experience and if the right calls were made then hospitals can be confident that the system is working, Smith said.
"Either way we learn from it and as a health care system in this county we do better," he said.
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